Provider Demographics
NPI:1528208709
Name:SLATTERY, KELLY A (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:SLATTERY
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:ATTARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 RIVERSIDE DR STE B
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-2707
Mailing Address - Country:US
Mailing Address - Phone:413-586-2000
Mailing Address - Fax:
Practice Address - Street 1:320 RIVERSIDE DR STE B
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-2707
Practice Address - Country:US
Practice Address - Phone:413-586-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN2843133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered